Okaloosa County BOCC — December 31, 2012 — APAC Final Payment — reading text

any gift or gratuity to, or made any financial transaction of any nature with, any employee of the Department in connection with obtaining or performing said contract. 3. All amounts payable for labor, materials, or otherwise, in connection with said contract and work have been paid excep for normal sub-contract retainages, which will be satisfied within 30 days after payment and/or release of retainage withheld under said contract. 4. There are no claims or suits pending against said Contractor or anyone in connection with the work done, materials furnished or otherwise, under said contract except as listed below. As to any such exception listed below, the Contractor has stated the name of the entity making the claim, the name of the entity against whom the claim is being made, and demonstrated below good cause as required by Section 337.11(10)(b), Florida Statutes. Claiming Entity Claim Agent Nature of claim Good cause explanation None State of Florida A false statement or omission made in connection with this County of E SCO o 1a qh rh affidavit is sufficient cause for suspension, revocation, or ; . denial of qualification to bid, and a determination of Sworn to and subscribed before me this day non-responsibility, and may subject the person and/or entity making the false statement to any and all civil and criminal of Novembk dev Dod by “Tur \stall ion Porry TV penalties available pursuant to applicable Federal and State Mund, S 9 (Print name of person signing an Law. YY £. SMALLWOOD - iN ain ’ ama Public _ - CCe aC Z : APAC MID-SOUTH, INC. t AG TE P Ante Ab! 1 BAN? Commit 017848 Oe EE. MLESPIE EAS” Expires 8/16/2014 = = Personally Known j~~ OR Produced Identification Punstall B. Berry WIA Vice President a Title Type of Identification Produced Rule 14-24, FAC. 700-050-21 CONSTRUCTION 08/04 We, the FEDERAL INSURANCE COMPANY _, duly authorized to do business under the laws of Florida, having (Type or printname of surety) heretofore executed a performance and payment bond for the Contractor covering the contract described above, hereby consent to the State of Florida Department of Transportation making full payment of the final estimate, including the retained percentage, to the Contractor. It is fully understood that consenting to the State of Florida Department of Transporation 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. IN WITNESS WHEREOF, the FEDERAL INSURANCE COMPANY has caused this (Type or print name of surety) instrument to be executed by its President, Chief Executive Officer or duly authorized Attorney-In-Fact and it's corporate seal to be hereto affixed, all on this 8TH day of NOVEMBER ' 2012 FEDERAL INSURANCE COMPANY (AFFIX SEAL) BY: : {J Its President or chift Executive Officer LISA HALL [Xi Its Attorney-In-Fact FL LICENSE NO. W043413 {J Florida Licensed Insurance Agent STATE OF UTAH (Attach Power of Attorney) COUNTY OF SALT LAKE to me well known or who Before me, the undersigned Notary Public, personally appeared LISA HALL has produced DRIVERS LICENSE as identification as the person described in and who executed the forgoing (Type of Identification) FEDERAL INSURANCE COMPANY surety, as its and LISA HALL ATTORNEY-IN-FACT instrument in the name of ATTORNEY-IN-FACT acknowledged that he/she executed said instrument in the name of said surety as its arate purposes therein expressed and that he/she has due and legal authority to execute the same on behalf of said surety. Sworn to and subscribed before me this 8TH day of NOVEMBER _ | 2012 My commission expires JULY 26, 2015 Notary Public, State of UTAH Notary Public JESSICA ARNOLD Commission Number 612061 My Commission Expires July 26, 2015 State of Utah =o S07 69 6S OS GO sy BG YO Fn SS On Om OW 80 BP POWER Federal Insurance Company Attn: Surety Department Chubb OF Vigilant Insurance Company 15 Mountain View Road GHUBB Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All 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 appoint Tina Davis, Lindsey Gates and Lisa Hall of Salt Lake City, Utah and Melanie Walker of Tulsa, Oklahoma -=----=-:-s0++-022=0= each as their true 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 behalf as surety thereon or otherwise, bonds on behalf of contractors in connaction with bids, proposals or contracts to or with the Department of Transportation, and any and all consents required by the Department of Transportation of Florida incident to the release of retained percentages and or final estimates on engineering and construction contracts. 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 5th day of July, 2011, 2 eS poe Nontis, Jr., Vice all STATE OF NEW JERSEY County of Somerset 8s. On this Sth day of July, 2011 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 Attorney, and the said Kenneth C. Wendel, being by me duly sworn, 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 Attorney 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. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwrjina of David B, Norris, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. ERINE J, ADELAAR Notarial Seal NOTARY PUBLIC OF NEW JERSEY __No, 2316685 Commission Expires July 14, 2014 VE he © Notary Public CERTIFICATION VY Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: “All powers of attorney 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 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 upon the Company with respect to any bond or undertaking to which it is attached.” |, 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, (ii) 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 Island; and (ili) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 8TH dayof NOVEMBER, 2012 Kenneth C. el, Secretary 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- 0153B-U (Rev. 5-03) FLA DOT MAINTENANCE BOND Bond Number: 8229-91-83 KNOW ALL MEN BY THESE PRESENTS, thatwe APAC MID-SOUTH, INC. as Principal, (the “Principal”), and Federal Insurance Company, a corporation organized under the laws of the State of Indiana, as Surety, (the “Surety’), are held and firmly bound unto OKALOOSA COUNTY BOARD OF COMMISSIONERS as Obligee (the “Obligee’), in the penal sum of TWO HUNDRED FORTY ONE THOUSAND SIX HUNDRED SEVENTY AND 10/100 Dollars ($241,670.10), for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. th WHEREAS, the Principal has by written agreement dated Dal ,ZO\2Z_. entered into a contract (the “Contract”) with the Obligee for RFB #PW 33-12 SYLVANIA HEIGHTS RESURFACING PROJECT which contract is by reference made a part hereof. NOW, THEREFORE, the condition of this obligation is such that if the Principal shall remedy without cost to the Obligee any defect which may develop during a period of ONE (1) year(s) from the date of completion and acceptance of the work performed under the Contract provided such defects are caused by defective or inferior materials or workmanship, then this obligation shall be null and void; otherwise it shall be and remain in full force and effect. DATED as of this 18TH day of OCTOBER, 2012. APAC MID-SOUTH, INC. (Seal) Principal ‘ WITNESS/ATTEST: ; 2 Dndy & Smobliccart MEE as Name: Title: Tunstall B. Perry Vice President FEDER INSURANCE COMPANY (Seal) ISA HALL, ‘aot Fact SURETY ACKNOWLEDGMENT STATE OF UTAH } COUNTY OF SALT LAKE } SS On this 18TH day of OCTOBER, 2012, before me personally came LISA HALL to me known, who, being by me duly sworn, did depose and say that she is an Attorney-In-Fact of FEDERAL INSURANCE COMPANY the corporation described in and which executed the within instrument; that she knows the corporate seal of said corporation, that the seal affixed to the within instrument is such corporate seal, and that she signed the said instrument and affixed the said seal as Attorney-In-Fact of the Board of Directors of said corporation and by authority of this office under the Standing Resolutions thereof. Shona _ Notary Public Notary Public JESSICA ARNOLD Commission Number 612061 My Commission Expires July 26, 2015 State of Utah poeoeesesee eeecesescon! [ Chubb POWER Federal Insurance Company = Attn: Surety Department u OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 CHUBB Know All 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 appoint Tina Davis, Lindsey Gates and Lisa Hall of Salt Lake City, Utah and Melanie Walker of Tulsa, Oklahoma ----+--=-=~ each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to